BioMed Analysis: Conventional innovation isn't enough

Innovating for health is about more than drug development. It means new ways of delivering and using existing technologies, says Priya Shetty.

Innovation is the driving force of progress, without which efforts to improve global health will always fall short of the mark, irrespective of how many millions of dollars are pumped in.

It has been encouraging that for some time there has been support for stimulating innovation to tackle diseases of the poor in developing nations. But conventional health innovation can be a risky business. Investigating a new drug or vaccine can cost millions of dollars and frequently ends in failure, and it is only the huge profits made on the small number of successes that ensures a return on overall investment.

The problem is that this does not apply to drug development for diseases in the developing world, where there is little hope of making a financial profit, regardless of success.

But spurring innovation to fight diseases of the poor is not beyond reach. It requires redefining what we mean by innovation.

Novel ways of doing

New technology — developing new drugs or medical techniques, for example — is vital, but we also need to change the social framework in which these innovations are used.

This could mean, for instance, finding better ways of transporting drugs to rural populations. Here the innovation is not a new drug or vaccine but improving an existing system in a novel way — which can yield far more powerful results than flashy new technologies.

Last November, the theme of the annual conference of the Global Forum for Health Research (GFHR) was 'innovating for the health of all' (see SciDev.Net blog). The conference aimed to highlight the different types of innovation that could revitalise global health.

Charles Gardner, innovation expert at the GFHR, told SciDev.Net why a broader look at innovation is important. "Products have little value unless they actually reach the people who need them," he said.

"Traditionally, we look for 'best practices' in product and service delivery — and think all we need is more money, doctors and nurses to scale up what works. Unfortunately, this is the road to stagnation. We need to start asking new questions."

What's the problem?

A small band of enterprising individuals across the globe are doing just that. Most ask communities what they need — and then focus their efforts on fixing one basic problem. For example, Joe Madiath, who set up Gram Vikas, a nongovernmental organisation (NGO) in India, has concentrated on improving sanitation in rural India.

His organisation has built thousands of toilets around the country, which seems unremarkable except for one crucial element. Unlike poorly constructed government efforts, the latrines are sustainable because they are built to survive India's harsh monsoons.

Meanwhile in Africa the global NGO, Riders for Health, has come up with an innovative way of coping with the parlous state of African roads, which hinders access to vital healthcare in many rural areas. Its team delivers healthcare to African villages by motorcycle and motorcycle ambulances.

These are two examples of so-called 'social innovation' — innovation based on changes in practices and procedures rather than new technologies. Today's biggest buzz in social innovation for health is mobile health or 'm-health'.

The developing world now has many initiatives that are harnessing mobile phone technology to improve healthcare — for example, rural clinics are sending text messages to remind HIV patients to wear condoms or take their pills. Other projects are sending patients their electronic medical records rather than attempting to lug heavy boxes of files from village to village (see Mobile phones can help manage diseases).

Incentives to scale up

But so far, these innovators have largely worked on their own, funded mainly by philanthropic organisations. Their efforts are working but the ad hoc approach risks duplicating effort, so we urgently need unity and collaboration to bring widescale benefits.

As Gardner comments, increasing the number and scale of such innovative changes in approach requires different incentives to those that fuel conventional technological innovation.

But how to create them is a mystery to the global health community, who, for the most part, remain caught up in debating the best ways of stimulating conventional research and development for neglected diseases.

We urgently need dedicated research and creative thinking to establish different drivers of innovation. Given enough political commitment and the collective know-how of academics and researchers, we can surely find out how to stimulate all types of innovation at the same time.

The process of innovation is, after all, an experiment to create something better. Like all worthwhile experiments, providing an open, collaborative environment that is tackling the right questions is more likely to lead to creative and beneficial solutions.

Journalist Priya Shetty specialises in developing world issues including health, climate change and human rights. She has worked as a news editor at New Scientist, assistant editor at The Lancet, and commissioning editor at SciDev.Net.